Pigmented lesions of the oral mucosa: epidemiological survey of 172 cases with focus on differential diagnosis

SARS-CoV-2 develops well in the oral mucosa because, it is the first contact area with the virus. The oral mucosa is highly expressed with angiotensin-converting enzyme 2 (ACE2) and makes the virus replicated in the epithelial cells and produce both oral lesions and oral symptoms. This review aimed to describe the oral mucosal symptoms and lesions related to SARS-CoV-2-infected patients that have been reported around the world. A literature search was performed on PubMed, ScienceDirect and Google Scholar, from February to October 5, 2020, focusing on COVID-19 (SARS-CoV-2) oral lesions and oral symptoms. Eighteen studies were identified with a total of 25 cases describing the oral symptoms and oral mucosal lesions of the SARS-CoV-2 infection. The oral symptoms related to the SARS-CoV-2 infection included dysgeusia, ageusia, a burning mouth sensation, a dry mouth and severe halitosis. The oral mucosal lesions varied from ulceration and depapilation to pseudomembranous, maculae, nodules and plaque. The mucosal lesions related to the skin lesions were in the form of crusty lips, multiple ulcerations and rashes, targeted lesions, blisters and vesiculobullous lesions. The manifestations of the SARS-CoV-2 infection in the oral cavity are non-specific. The oral mucosal lesions that occur mimic the Herpes zoster virus infection, the Herpes simplex virus infection, Varicella and hand, foot and mouth disease, and the oral mucosal lesions with the skin manifestations (e.g. erythema multiforme).

<table border="0" cellspacing="0" cellpadding="0"><tbody><tr><td valign="top" width="456"><p>Introduction: Pigmented lesions of the oral mucosa are numerous and are caused by abnormal collection of melanin or endogenous and exogenous pigments. There are two categories of pigmented lesions: melanocytic and nonmelanocytic lesions. Melanocytic lesions include oral melanotic macules, drug-induced pigmentations (minocycline, antimalarials, some chemotherapeutic agents, oral contraceptives…), smoker's melanosis, oral melanoacanthoma, melanocytic nevi and melanoma. Nonmelanocytic pigmentation includes amalgam tattoos, a common material used for dental restorations. Differential diagnosis requires a careful medical and medication history and a complete head and neck physical examination. In some cases, biopsies can be taken and imaging studies are also helpful.</p><p>Methods: We report a 53-year-old male patient with a smoking history. The patient was referred to our service by his dentist with a history of an asymptomatic lesion on the tongue. Intraoral examination showed a brown, well-circumscribed macule on the right hemi-tongue ventral surface and an indurated 20 x 5 mm lesion. The rest of the physical examination was normal. Magnetic resonance imaging (MRI) showed no significant findings. Anatomopathological study was performed and confirmed the diagnosis of oral melanotic macule.</p><p>Conclusion: Melanocytic lesions of the oral mucosa are numerous and range from benign conditions to malignant ones such as melanoma. Differential diagnosis is particularly important and requires a careful medical history, complete head and neck physical examination and anatomopathological study.</p><p> </p></td></tr><tr><td valign="top" width="456"><p> </p></td></tr><tr><td valign="top" width="456"><p>Keywords: oral melanotic macules, smoker's melanosis, oral melanoacanthoma, melanocytic nevi, melanoma.</p><p> </p></td></tr></tbody></table>

Background: Interest in the study of combined pathology has recently been explained by the accumulation of new facts, the emergence of new information about interorgan, intertissue and intercellular levels of interactionin the system of the whole organism. Studies of the oral cavity in chronic diffuse liver diseases are of great interest to clinicians, since pathological processes developing in the liver, as a rule, lead to organic and functional disorders in the oral mucosa. The aim of this study was to study the clinical and morphological lesions of the oral mucosa and periodontium in viral hepatitis C. Material and methods: 196 patients were examined, of which: the control group consisted of 100 patients with lesions of the oral mucosa (OM) and periodontal disease who were not diagnosed with HCV and 96 patients of the main study group. Dental status was studied. A pathological examination was carried out. Results: HCV patients group included 96 (63.5% males) and non-HCV group - 100 subjects (62.0% males) with lesions of oral mucous membrane. The lesions of lips and oral mucosa were more frequent in HCV than in the non-HCV group – e.g. erosion (13.5% vs 1%), cracks in the mouth corners (42.7% vs 0%), changes of oral mucosa surface (89.6% vs 3.0%), hemorrhages - (78.1% vs 0%) etc. Conclusion: Thus, during the clinical examination of patients with HCV, the average severity of periodontal damage prevailed. Numerous morphological features can be divided into those that are indicators of the severity and activity of inflammation.

The objective of the present study was to explore the clinical characteristics of BP180NC16a autoantibody-positive mucous membrane pemphigoid. Data from 22 patients were collected by retrospective chart review. For the detection of BP180NC16a autoantibody, a commercially available enzyme-linked immunosorbent assay or chemiluminescent enzyme immunoassay kit was used. The patients were classified into the following clinical phenotypes: low-risk patients who had lesions only in the oral mucosa or in the oral mucosa and skin and high-risk patients who had lesions in the oral mucosa and any of the following sites: the eyes, upper respiratory tract, or esophagus. Eleven of the 22 patients (50%) were BP180NC16a-positive at the time of diagnosis. All the positive patients were in the low-risk group. There was a significant difference in the incidence of low-risk mucous membrane pemphigoid between BP180NC16a autoantibody-positive and BP180NC16a autoantibody-negative patients (p=0.004). Patients' age, disease duration, and oral disease activity scores were not significantly different between the two groups. BP180NC16a reactivity was associated with the clinical phenotype characterized by only oral mucosal lesions or combined oral mucosal and skin lesions. BP180NC16a autoantibody might be useful as a serum marker to predict low-risk mucous membrane pemphigoid.

Introduction: India ranks second in the total incidence of oral cancer. The purpose of the present study is to identify the predictive risk factors for potentially premalignant oral mucosal lesions among a vulnerable Indigenous community in Bhopal. Materials and Methods: A cross-sectional study design with a prevalidated questionnaire including the demographic characteristics, tobacco usage, and other predictive risk factors was used to survey subjects aged between 15 and 75 years, both males and females of the Gond community in the Bhopal division. Type III Oral examination was conducted to determine oral mucosal changes. Statistical Analysis: Descriptive statistics were done to estimate the prevalence of oral premalignant mucosal lesions (OPMLs) and the demographic characteristics of participants. Chi-square statistics was employed to analyze the association between predictive risk factors and with the prevalence of oral premalignant lesions. Linear logistic regression was done to correlate the significance of predictive risk factors of OPMLs. P ≤ 0.05 was considered statistically significant. Results: A statistically significant association for OPMLs was observed with tobacco use, alcohol, and tobacco with alcohol usage and gender (P = 0.00). OPMLs do not show any significant association with trauma, oral ulcers, or dentures (P ≥ 0.05). The most common lesion identified was leukoplakia (39.1%), followed by Oral sub mucous fibrosis (33.33%) and both (16.66%). Lesions were most commonly seen on the buccal mucosa (60.3%), followed by the tongue (21.8%) and alveolar ridge/gingiva (9.6%). Logistic regression of predictive risk factors showed a significant correlation of OPMLs with smokeless, smoking, alcohol, and tobacco with alcohol usage. Conclusion: There is a higher burden of OPMLs and increased tobacco consumption observed in the Gond community residing in the rural areas of Bhopal. The increased burden of tobacco usage and oral mucosal lesions needs to be addressed, and interventions, including tobacco cessation counseling and awareness of oral hygiene practices, should be made feasible for the problem.

Can Artificial Intelligence (AI) assist in the diagnosis of oral mucosal lesions and/or oral cancer?

BackgroundIn this cross-sectional study we investigated the oral mucosal changes in a middle-aged Finnish population. We analyzed the prevalence of potentially malignant disorders and the influence of smoking, snuff and alcohol use on the mucosal changes.MethodsOf the 12,068 members of the NFBC 1966, a total of 1961 participants (16.2%) constituted the study population. Mucosal changes were diagnosed and photographed by seven general dentists, and two specialists re-analyzed all the diagnoses based on the documentation Cross-tabulation with Chi-square tests and logistic regression analysis were used to analyze the data.ResultsOf the participants, 10.5% had some mucosal changes, of which 81.8% were diagnosed as oral mucosal lesions (OML) and 18.2% as normal variations. Of the normal variations, the most common were Fordyce granules (1.2%), fissured tongue (1.1%) and geographic tongue (0.9%). The most common OMLs were white lesions (6.5%), of which oral lichen planus (OLP) and lichenoid reactions (OLR), grouped as oral lichenoid diseases, were present in 3.5%, males more often (3.8% vs. 3.1%). OLP was found in 1.5% of all participants, females more often (1.8% vs. 1.2%), while OLR was more common in males (2.7% vs. 1.3%). Leukoplakia was identified in 0.5% of the population; twice more often in males (0.6% vs. 0.3%). Erythroplakia was not found. Current smokers had higher risk for oral mucosal changes than former or non-smokers (OR 3.0, 95% CI 2.11–4.28), and snuff, used occasionally or regularly, also raised the risk (OR 2.6, 95% CI 1.48–4.70).ConclusionsIn the middle-aged northern Finland population, 4% of OMLs were potentially malignant disorders, including OLR (2%), OLP (1.5%) and leukoplakia (0.5%). In particular, smoking and snuff use increased the risk for having any oral mucosa changes.

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals. To evaluate the oral mucosal status in the elderly population of different age group and fnd out the association of age, gender and denture with oral mucosal disorders. The study sample consisted of 570 geriatric persons concentrating mainly on the oral mucosal changes or lesions occurring in the geriatric population. Individuals those are aged above 60 years were selected, and all the examined geriatric persons were categorized into 3 age groups to fnd out the association of oral mucosal lesions in each group. Group I-60 to 65 years, Group II-66 to 70 years, Group III-71 and above years. The sample of 570 elderly patients included 279 (48.95%) men and 291 (51.05%) women in three age groups: 61 to 65 years (40.35%), 66 to 70 years (31.05%), and 71 years and older (28.60%). The sample included 254 (44.56%) dentate patients, 205 (35.96%) denture wearers (partial and complete denture wearers) and 111 (19.47%) edentulous persons who lacked dentures in both the jaws. Almost half of the patients examined (48%) had one or more oral mucosal lesions. The 48% of the patients who presented with oral mucosal lesions, twenty fve different oral mucosal conditions were identifed and the three most common fndings were lingual varices (13.68%), denture induced infammatory fbrous hyperplasia (4.21%), squamous cell carcinoma (4.21%). There was some differences in the distribution of oral mucosal condition among the sexes. Leukoplakia and dysplasia were signifcantly associated with men (p < 0.001) whereas the association of fbroma and lichen planus with women were signifcant (p < 0.001). In our study it was found that patients in groups II and III had more prevalence of oral mucosal disorders. Lingual varices, oral squamous cell carcinoma, fbroma and denture induced infammatory fbrous hyperplasia were more commonly associated with the geriatric patients. The oral lesions (fbroma and lichen planus) were strongly associated with women while leukoplakia was strongly associated with men. Ageing is an important factor that can infuence the occurrence of mucosal lesions and with age the oral mucosa becomes more permeable to noxious substances and more vulnerable to external carcinogens.

Aim: This study aims to analyze the potential therapeutic effect of cannabidiol use on oral mucosa lesions in clinical and in vivo studies. Methods: A scoping review was conducted considering the question: “Is there a therapeutic effect of the use of cannabidiol (CBD) on lesions of the oral mucosa?”. Four distinct databases were searched (PubMed/MEDLINE, Embase, Web of Science, and Scopus) and gray literature until August 2023. Original clinical and in vivo studies were included, involving human and animal subjects where CBD was applied topically to the oral mucosa or administered systemically for the treatment of lesions or superficial/deep alterations of the oral mucosa. Results: A total of 610 records were found in the initial searches. Twelve studies were assessed in full text for eligibility and five studies were excluded. Seven studies were included in this review. Five studies were conducted with in vivo design and only two studies had clinical design in humans. Considering results from in vivo studies, all of them presented better clinical results for oral mucosa lesion groups treated with CBD-based therapy compared to placebo. Regarding histological features, four studies found statistically significant improvement in CBD-based therapy and only one study did not find a significant improvement. For clinical studies, all studies presented positive clinical results (primarily regarding pain control) in the use of CBD-based therapies. Conclusion: CBD appears effective in treating oral mucosa lesions (oral mucositis, ulcers, burning mouth syndrome). CBD-based therapies can reduce inflammation in vivo studies and hold promise for pain control and lesion healing in oral mucosa lesions in clinical studies. However, the limited number of clinical trials, heterogeneity in cannabis-based therapies, and a lack of standardized protocols underscore the need for further rigorous, interdisciplinary research to establish consistent dosing and assess the efficacy of various cannabinoids in treating oral mucosa conditions.

Aims: Oral mucosa, tongue, dentition and bone are important parameters for oral and systemic health care. A wide variety of lesions and conditions, either harmless or harmful, can affect the oral cavity. Identification and treatment of these conditions are an important part of oral health care. The aim of this study was to evaluate the general oral health status, by assessing the prevalence and types of mucosal, tongue, dental and jaw lesions, in a group of patients. Materials and methods: This study was conducted in a group of 314 dental outpatients. Participants’ oral mucosal, tongue, dental, jaw lesions and their locations were recorded. Data were analyzed using logistic regression analysis. Results: Three hundred and fourteen patients (40,1% female, 59,9% male), 148 (47,1%) of whom exhibited one or more mucosal lesions, 40 (12,7%) tongue lesions, 242 (77,1%) one or more acquired dental conditions, 61 (19,4%) one or more dental anomalies, and 22 (7%) bone manifestations in the jaws. The most commonly detected mucosal lesions were Fordyce’s granules (20,1%), linea alba buccalis (16,9%), melanoplakia (15,9%), and frictional keratosis (2,5%). Fissured tongue (8%), geographic tongue (1,6%), lingual varicosity (1,3%) and coated tongue (1,3%) were the most commonly determined tongue lesions. The most commonly detected dental anomalies were hypodontia (6,1%), microdontia (4,1%), dilaceration (4,1%), and enamel hypoplasia (2,5%). Exostoses (4,1%), enostoses (1%) and fibro-osseous lesions (1%) were the most commonly detected bone manifestations in the jaws. Conclusions: Oral mucosal and tongue lesions could be a sign of systemic diseases and also could form a base for oral cancers. In this study oral mucosal lesions and tongue lesions prevalence were high but fortunately all the detected conditions were harmless, benign conditions. This emphasizes the importance of familiarity, awareness, and differentiation of these lesions and conditions to avoid unnecessary treatments.

White sponge naevus (WSN) is a rare, benign, autosomal dominant disorder that involves non cornifying stratified squamous epithelia: predominantly the oral mucosa, less frequently nose, oesophagus, anogenital area. This is an inherited condition, but in literature we can find also case report with negative familial background. Clinically it is characterized by asymptomatic, bilateral, white, soft and spongy plaques in the oral mucosa and the onset is usually in early childhood. The histological features include epithelial thickening, parakeratosis and vacuolization of the suprabasal layer of oral epithelial keratinocytes. In 1995 Richard et all and Rugg et all show that mutation in the mucosal K4 and/or K13, the specific keratins of the buccal, nasal, esophageal mucosae and anogenital epithelia, is associated with WSN. Even if it is a benign condition, it is important to make a differential diagnosis from other white lesions of the oral mucosa, that are potentially malignant. No standard treatment exists, although numerous therapies have been tested. We report a case of a young female patient who presents oral WSN, treated successfully with topical tetracycline; in our case we have used tetracycline ophthalmic cream, because in Italy there is no tetracycline solution.

Actuality. In the treatment of erosive-ulcerative lesions of oral mucous membrane, caused by chronic mechanical trauma, it is reasonable to use the agents of complex action which would produce a local anti-inflammatory effect and reduce mucosal pain, and would have antiseptic and antimicrobial properties. One of them is Tantum Verde®, a local non-steroidal drug based on benzidamine hydrochloride.The aim of the research was to evaluate the effectiveness of the use of the preparation «Tantum Verde®» in the local treatment of erosive-ulcerative lesions of the oral mucous membrane caused by chronic mechanical trauma.Results of the research. There were treated 30 patients aged 18–58 with erosive-ulcerative lesions of oral mucous membrane, caused by chronic mechanical trauma of orthopedic structures or orthodontic devices. It was noted that 6 patients with removable prostheses had the growth of mucous membrane in areas of contact with the edges of the prosthesis. Among 15 patients from the experimental group, the preparation «Tantum Verde®» was additionally used. Absence or significant reduction of clinical signs of erosive-ulcerative lesions caused by mechanical trauma of orthopedic structures or orthodontic devices occurred 1–1,5 days earlier among the patients of experimental group. It is noted the positive effect of Tantum Verde® on pain reduction, hygienic condition, improvement of tissue trofics and healing of mucous membrane areas after surgical removal of prosthetic granulomas.Conclusions. The preparation «Tantum Verde®» is an effective painkiller that accelerates the disappearance of inflammatory signs, improves trophics, accelerates healing and epithelization of defects at patients with erosive-ulcerative lesions of oral mucous membrane, caused by chronic mechanical trauma with dental prostheses and non-removable orthodontic devices. It weakens the reactive inflammatory reaction of tissues to surgery after prosthetic granulomas removal, improves hygiene, accelerates healing and suture removal for 1–1,5 days.Keywords: «Tantum Verde®», chronic mechanical trauma of oral mucous membrane, erosive-ulcerative lesions, local treatment.

To evaluate the incidence of tobacco-related oral mucosal lesions in the adult population visiting ENT-OPD at Shri Maharaja Gulab Singh Hospital, GMC Jammu, India. From December 2021 to November 2022 we attempted to compile the prevalence of tobacco-induced oral mucosal lesions in the adult population visiting ENT-OPD at Shri Maharaja Gulab Singh Hospital Jammu, India. The study included a total of 400 patients of various age groups. The patients were divided as current users with a habit of tobacco consumption for atleast 6months and ex-users who had used any form of tobacco in their lifetime for a minimum of 6months but had abstained the use since last 1year. Age group, gender, employment, type of tobacco use, site of placement of tobacco in the oral cavity, frequency and duration of use, and the types of mucosal lesions were all documented on a standardized interviewer-based questionnaire.The oral mucosal lesions were diagnosed in accordance with international recommendations. Males (55%) had somewhat more oral mucosal lesions than females (45%). Oral submucous fibrosis was found in 110 individuals, followed by leukoplakia in 102, erythroplakia in 14, tobacco pouch keratosis in 81, tobacco induced melanosis in 82 patients and malignancy in 11 patients. 107 conventional smokers (26.75%), 254 patients using smokeless tobacco (63.5%) and 39 patients using combined form of tobacco (9.75%) showed oral mucosal lesions. The most prevalent site of lesions was the labial comissure, which showed 117 lesions (29.25%), followed by 114 lesions on the buccal mucosa (28.5%), and 99 lesions (24.75%) on buccal sulcus. Gingiva showed 41 lesions (10.25%), tongue had 15 entities (3.75%) and palate had 14 (3.5%). The most frequent oral mucosal lesion was shown to be oral submucous fibrosis, followed by leukoplakia. Smokeless tobacco was the most commonly used tobacco product. This study emphasizes the need of routine evaluation of the oral mucosa and the need for patients to be urged to stop this hazardous behavior.

Relevance. The prevalence of oral mucosal diseases among the Russian population varies from 3% to 20% [7]. Precancerous and malignant diseases are a particular problem. More than nine thousand new cases of malignant oral mucosal lesions are registered annually in the Russian Federation, and yearly mortality rates reach 34%. Unfortunately, despite being externally located, the rate of late-diagnosed malignant oral mucosal neoplasms reaches 60%-70% in various regions of the Russian Federation [2]. Thus, one of the most urgent problems in dentistry and oncology is the early diagnosis of precancerous and malignant oral mucosal lesions. As a rule, precancerous lesions are not diagnosed at an early stage since there are no visible clinical signs, and therefore patients do not seek medical attention [8]. An accurate diagnosis requires both basic and additional examination methods. In turn, the conventional methods include traditional inspection, which largely depends on the clinician's experience. Besides the clinical examination, additional techniques are used, namely, fluorescence examination and biopsy [9-11]. Subsequently, optimizing the diagnosis of oral mucosal lesions is the most promising direction in practical healthcare, both in the dental and oncology practice, for early detection and reduction of advanced stages of malignant oral mucosal lesions. Thus, the study confirmed that the development and application of modern approaches are necessary for the early diagnosis of oral mucosal lesions. Purpose. The study aimed to improve the outcome of oral mucosal precancerous and malignant lesion diagnosis by upgrading examination methods. Material and methods. The study included 147 patients with oral mucosal lesions, referred to the oncologists of Samara regional clinical oncology centre by the city polyclinics. The patients were divided into two groups according to the examination methods. The control group patients, 63 people, had a conventional examination by a dentist (patient interview, inspection, palpation) and an incisional biopsy by an oncologist. The main group consisted of 84 patients, who, besides conventional dental examination, were evaluated by a new – developed and put into practice – technique with point and index score and subsequent incisional biopsy performed by an oncologist. The studied patients were comparable by gender, age and localization. The study assessed the effectiveness of the new method for the diagnosis of precancerous lesions (PL) and malignant lesions (ML) by matching the Need for Histology Verification Index (NHVI) value equal to 5 points or more and histopathology results.Results. In the main group, 71 out of 84 patients scored 5 or more according to the new method, and 13 patients scored less than 5. Patients with a low score had a non-surgical treatment, 11 patients reached remission, and two patients were referred to an oncologist for a biopsy, which confirmed oral mucosa PL and ML. The patient complaints in both groups demonstrated that pain and bleeding were more frequent in the control group compared to the main one. The evaluation of clinical examination data revealed more erosions in the control group and nonremovable plaque and hyperplasia in the main group. The incisional biopsy detected more PL and ML in the main group (p = 0.001), and early malignant lesions were in 23% versus 5% in the control group. The new method specificity in oral mucosal PL and ML diagnosis was 55%, sensitivity – 97%, accuracy – 87%, whereas the conventional examination specificity was 28%, sensitivity – 84%, and accuracy – 60%.Conclusion. The administered improved method for examination of patients with oral mucosal lesions and the compulsory use of autofluorescence examination and risk factor score assessment allowed us to identify PL and ML in 88% and to diagnose more PL and ML at early stages, which explains the need to use this method in the clinical practice for the early diagnosis of lesions.

Aims and Objectives: To determine the frequency and common site of fungal infection in biopsies of oral mucosal lesions and also to detect the lesions most likely to be infected with fungal infection. Materials and Methods: A total of 100 patients with oral mucosal lesions were advised routine hematological examination followed by incisional biopsy under local anesthesia. The specimen were fixed in 10% neutral buffered formalin and processed. One section from the specimen was stained with hematoxylin and eosin staining for histopathological diagnosis of the lesion and a second section was stained with Periodic acid-Schiff (PAS) stain for detection of fungal infection. Results: Out of the 100 patients, the most common mucosal lesion encountered was carcinoma (56%) followed by lesions with dysplastic changes (28%), benign lesions (9%), squamous papilloma (2%) and oral submucous fibrosis (5%). The most common anatomic location affected by the mucosal lesions were buccal mucosa, followed by the tongue, gingiva, maxillary tuberosity and floor of the mouth with values of 73%, 16%, 6%, 4% and 1%, respectively. Squamous papilloma had the highest positive association with fungal infection (100%) followed by lesions with dysplastic changes (17.9%) and carcinoma (8.9%). The maximum fungal positive association was encountered in the mucosal lesions over the tongue (18.7%) followed by the buccal mucosa (12.3%). Conclusion: There is statistically significant association of fungal infection with dysplastic lesions and papilloma with the tongue and buccal mucosa as the most common sites. Hence a PAS stain should be performed whenever epithelial dysplasia on the tongue and buccal mucosa is diagnosed.